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First and last name
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Your answer
City in which you attend Shrine meetings (club or temple)
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Your answer
Are you staying occupied during these Covid-19 times?
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Yes
No
Some days
Are you staying healthy?
*
Yes
No
Depends on the day....
So, so....
Sucks to get old!
Would you like someone from Ballut Abyad to check in with you?
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Yes
No
If yes to the question above, do you have a particular someone, like the Chaplain, or just anyone to check in on you?
Your answer
If yes, please provide a method to contact you. (Good phone number or email address)
Your answer
Do you have any news, information or short story that you'd like to share with us? If so, please do.
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